A buzzy diabetes drug that’s been hailed as a longevity booster may have some competition.
The decades-old medication metformin has been touted for everything from treating Type 2 diabetes and reducing the risk of long COVID to potentially slowing the aging process. But a new study published in JAMA found that another intervention did a better job of reducing the risk of developing multiple chronic diseases over two decades of follow-up.
And unlike a prescription medication, it’s available to virtually everyone.
The findings come from an analysis of participants in the landmark Diabetes Prevention Program (DPP) and its follow-up study, the Diabetes Prevention Program Outcomes Study DPPOS, which tracked thousands of adults from 1996 through 2021.
The winning strategy? Rigorous exercise and a healthy, balanced diet.
Researchers found that among adults with prediabetes, lifestyle intervention — specifically a low-fat, low-calorie diet and at least 150 minutes of physical activity each week — was associated with a lower burden of multimorbidity over more than two decades of follow-up.
Metformin, meanwhile, performed no better than a placebo.
Multimorbidities refers to having two or more chronic health conditions at the same time. In this study, researchers looked at 15 common conditions in the Medicare claims database, including hypertension, cancer, dementia, Alzheimers disease, chronic kidney disease, heart failure, osteoporosis and stroke.
The original program enrolled 3,234 adults at high risk of developing diabetes. Participants were randomly assigned to intensive lifestyle intervention, metaformin or placebo for three years before entering a long-term follow-up study.
Among 1,173 participants enrolled in Medicare and followed for 21 years, 82% of those in the lifestyle intervention group developed multimorbidity, compared with 85% in the metformin group and 87% in the placebo group.
Researchers say that the study is especially important because efforts to prevent or slow multimorbidity have largely fallen short in real-world medicine. Once patients start accumulating multiple illnesses, it’s been difficult for doctors to meaningfully stop that progression, since the conditions tend to feed into each other over time.
That challenge is even more pressing given the rise of what the study authors referred to as “high-cost condition dyads,” combinations of chronic diseases such as heart failure and kidney disease, or cancer paired with mental health conditions, which make up a disproportionate share of healthcare spending and complexity.
Against that backdrop, the study’s authors turned to metformin and lifestyle intervention because both have already been shown to reduce the risk of type 2 diabetes in high-risk patients.
The question was whether either approach could also extend those benefits further and blunt long-term multimorbidity.
Dr. Shirin Jaggi, DO, an endocrinologist at Northwell Health who was not involved in the study, described the findings as “powerful,” as she would be able to “speak with my patients and tell them it’s not just a pill that I need to give you.”
She also emphasized that lifestyle changes are not one-size-fits-all and “could be very different” for everyone, stressing the importance of adopting healthier nutrition and fitness habits gradually over time.
“We have to start slow and work our way up to it,” Dr. Jaggi told The Post, noting the importance of frequent check-ins with patients to see whether goals are being met. “So, for somebody who’s been sedentary, we work slowly, whether that means including 10 to 15 minutes once or just twice a day, and then working our way up.”
As America’s population continues to age, multimorbidity has become increasingly common among adults ages 65 and older. Preventing or delaying its onset is considered one of the biggest challenges in modern healthcare.
“For me to be able to tell patients that there is something they can do beyond prescription, which could be even more powerful than a prescription, I think it’s amazing,” said Dr. Jaggi. “I think it gives patients motivation.”
